Pain Disease Inquiry Need to Know Complaint: History: Trigger ( ), Onset ( ), Location ( ), Duration ( ) Wang Xinchun, Department of Rehabilitation and Pain, Qinghai Hospital of Traditional Chinese Medicine Nature: Sharp pain ( ) Distension ( ) Stabbing pain ( ) Throbbing pain ( ) Cold pain ( ) Scurrying pain ( ) Squeezing pain ( ) Drilling pain ( ) Spasmodic pain ( ) Radiating pain ( ) Cutting pain ( ) Dull pain ( ) Sour pain ( ) Strangulation pain ( ) Cramping pain ( ) Numbness pain ( ) Tearing pain ( ) Tearing pain ( ) Tension pain ( ) Pain ( ) Electric shock pain ( ) Heavy pain ( ) Pain ( ) Burning pain ( ) Strength: (none Mild, moderate, severe, severe, most ) Aggravating factors: Relieving factors: Accompanying symptoms: (none Mild, moderate, severe, most ) Dor ( )dor de choque elétrico ( )dor intensa ( )dor envolvente ( )dor em queimadura ( ) Intensidade: (nenhuma Ligeira Moderada Pesada Dramática A maioria ) Factores agravantes: Factores atenuantes: Sintomas acompanhantes: Tratamento: Tratamento atual: Estado geral: Mental ( ) Dieta ( ) Sono ( ) Fezes ( ) Urina ( ) Esforço físico ( ) Peso ( ) Antecedentes: Saúde ( ) Doença infecciosa ( ) Cirurgia ( ) Trauma ( ) Alergia ( ) Outros antecedentes médicos ( ) Antecedentes pessoais: ambiente ocupacional ( ) hábitos de vida ( ) história de tabaco e álcool ( ) história familiar: